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Intraventricular antibiotics for bacterial meningitis in neonates
1Shared Program in Neonatal-Perinatal Medicine, Division of Neonatology, University of Toronto, 600, University Avenue, Room 775A, Toronto, M5G 1X5, Ontario, Canada. sshahdoc@hotmail.com
The Cochrane Database of Systematic Reviews
|October 21, 2004
Summary
Intraventricular antibiotics, when added to intravenous treatment for neonatal meningitis, significantly increased mortality risk in a single trial. This approach should be avoided due to safety concerns in treating gram-negative meningitis.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Neonatal meningitis, particularly gram-negative bacterial infections, presents challenges in eradicating pathogens from cerebrospinal fluid (CSF) with standard intravenous antibiotics.
- Intraventricular antibiotic administration theoretically offers higher CSF concentrations but carries risks associated with ventricular taps.
- Ventriculitis, an inflammation of the brain's ventricles, often accompanies meningitis and complicates treatment.
Purpose of the Study:
- To evaluate the efficacy and safety of intraventricular antibiotics, with or without concurrent intravenous antibiotics, for treating neonatal meningitis and ventriculitis.
- To compare outcomes against standard treatment using only intravenous antibiotics in neonates.
- To assess effects on mortality, neurodevelopment, hospitalization duration, and bacterial clearance.
Main Methods:
- A systematic review of randomized and quasi-randomized controlled trials was conducted, searching major medical databases up to June 2004.
- Studies included neonates (< 28 days) with meningitis, comparing intraventricular plus intravenous antibiotics versus intravenous antibiotics alone.
- Data analysis utilized fixed-effect models to calculate relative risk, risk difference, and mean difference with 95% confidence intervals.
Main Results:
- One trial involving neonates and older infants with gram-negative meningitis and ventriculitis was included.
- Intraventricular gentamicin combined with intravenous antibiotics showed a statistically significant threefold increase in mortality risk (RR 3.43) compared to intravenous therapy alone.
- No significant difference was observed in the duration of CSF culture positivity between the groups.
Conclusions:
- The addition of intraventricular antibiotics to intravenous treatment in the studied trial resulted in a higher mortality rate.
- Based on this evidence, intraventricular antibiotics, as administered in this trial, should not be used for gram-negative meningitis in neonates.
- Further research comparing these specific interventions in this population is not warranted due to the demonstrated harm.